Roll-Over

This is a series of poses for labor when progress is slow. Contractions help this technique to work effectively. Penny Simkin and Ruth Ancheta call it the Roll-over and it is featured in their Labor Progress Handbook.

At Spinning Babies®, I’ve said, when you want to move the baby, move the mother. This technique literally rotates the mother to help the baby rotate! We’ve used variations of this technique for many years.

What is the Roll-over?

The Roll-over is a series of gravity-friendly maternal positions in which the birthing woman rests in eight positions as she “rolls over.”

Why use the Roll-over?

The various positions give the woman a variety of positions to rest in that may assist labor progress. This may be to rotate the baby, but also just to simply let the baby “explore” which position helps descent. Sometimes, one particular position is noticeably more effective, and for other labors, it’s a combination of all of the positions and the movement of the mother.

When a woman is confined to the bed because of blood pressure concerns or due to the numbing effect of an epidural or narcotics, her support people can help her change positions. The Roll-over is a great way to keep track of which position to choose next – it’s simply the next position you would use if you were rolling over and stopping at each quarter turn or less.

When to use the Roll-over

Unlike many of the techniques on the Spinning Babies® website, it is OK to use this technique even when labor is progressing regularly. In the case of “normal” labor, the idea is simply to rest in various gravity-friendly positions.

When labor contractions are coming regularly and somewhat strong (or quite strong) but progress has either stalled or is slow. The baby may be known to be in a posterior position, or has his or her head deflexed (the chin is up or not well-flexed).

The Roll-over can be used in pregnancy, too.

How to use the Roll-over

Start with the Hands-and-Knees position. For two to three contractions, the mother rests on her hands and knees. She can certainly have her forearms resting over the raised back of the hospital bed or leaning on a birth ball to save her wrists from strain.

After three contractions, the mom lays on her side. Either side. Let’s say left side. A long pillow or rolled blanket separates her knees AND ankles to reduce pulling on her pelvic ligaments. She lies with the right hip directly over her left. Her back is straight and she doesn’t lean forward or backward in bed.

After three contractions, she rearranges herself so that she is now leaning quite forward. A pillow is there for her higher shoulder. The pillow between her legs is moved in front of her abdomen so that her right knee can be bent and rest upon a high pillow. I call this “left lean-over.” It’s a common “Bradley class” relaxation pose. The mother’s belly button points into the mattress as much as possible without lying on the baby. A pillowy nest will raise the mother’s pelvis and ribs a bit to give baby room, if needed.

After three contractions, the birthing mom gets into an Open-Knee Chest position if she is able to move readily (if a woman is “on an epidural” she will need a lot of help and some open-minded providers!). If not, she goes to the next position.

After three contractions, she lies on her right side, Right-right angle.

After three contractions, she lies on her right side, leaning forward as described above for the Left-lean over. So she is now, Right-right angle.

She starts again with Hands and Knees position. Continue this for two more rounds, if that is even necessary.

Notes:

There are two ways to lay on one’s side. Leaning over or with hips stacked and a pillow from knee to ankle. Use both.

A fun way to be belly down is to lie on pillows with two semi-inflated swim rings to support the bump. A pillow under the pubic bone, breasts, and to lift the feet are essential.

You can find the original “Roll-over” drawings in the Labor Progress Handbook for better clarity. This is Penny Simkin and Ruth Ancheta’s actual and original Roll-over.

Roll-over to get to 10 centimeters dilation

The Roll-over is also useful to reduce an anterior lip. An anterior lip is when a bit of cervix, less than a complete circle of cervix, is coming in front of the head. The mother wants to push or the caregiver wants her to push. Instead of having the caregiver manually push the cervical lip back over the head (which doesn’t address the cause), the mother might try a round of the Roll-over techniques.

Roll-over for flexion

The Roll-over may also be useful for helping the lifted chin to tuck. When the caregiver can feel the front fontanel during a vaginal exam, this technique may help the chin tuck, which means, increase the flexion of the head (neck). The baby whose head is flexed fits the pelvis better, can rotate more easily and can descend more easily. Sometimes head flexion is the difference between a long labor or even a cesarean and a vaginal birth.

Around the country, nurses, doulas, and midwives praise the effectiveness of this series of maternal positions. Some call it flip-flop. But I have another series of techniques for resolving shoulder dystocia that I call Flip FLOP, so I chose the same name used in the Labor Progress Handbook by Penny Simkin and Ruth Ancheta. Visit PennySimkin.com to buy the 3rd edition of the Labor Progress Handbook! This is one of the most important books available to avoid that unwanted cesarean due to a slight malposition in the baby’s head.

When not to do this

Of course, some positions should be avoided if the mother has high blood pressure or the baby gives a deceleration in the heart rate during that position. These are rare occurrences that don’t warrant us avoiding the technique unless proven otherwise. Use discretion, but also confidence.

Before any series of activities using gravity and motion, I like to suggest activities for balance. The Sidelying Release may be helpful when possible.

Next: If this set of general postures doesn’t work in an hour or two, get specific to the baby’s station and presentation to choose specific techniques. Of course, that can be done before, depending on the time you have.

Try the lunge, dangle or dangle while grasping a rope or shawl overhead.

The Roll-over is a favorite in Labor and Delivery wards. If the laboring woman must be in bed, this is a good option! Add a bed-lunge as needed to open the midpelvis.

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